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01-02-2013 | Colorectal Cancer

Significance of Serum Tumor Marker Levels in Peritoneal Carcinomatosis of Appendiceal Origin

Authors: Patrick L. Wagner, MD, Frances Austin, MD, Magesh Sathaiah, MD, Deepa Magge, MD, Ugwuji Maduekwe, MD, Lekshmi Ramalingam, MD, Heather L. Jones, MPA-C, Matthew P. Holtzman, MD, Steven A. Ahrendt, MD, Amer H. Zureikat, MD, James F. Pingpank, MD, Herbert J. Zeh III, MD, David L. Bartlett, MD, Haroon A. Choudry, MD

Published in: Annals of Surgical Oncology | Issue 2/2013

Abstract

Background

The significance of tumor markers in patients with appendiceal carcinomatosis is poorly defined. We determined preoperative and postoperative tumor marker levels in patients undergoing cytoreductive surgery (CRS) and heated intraperitoneal chemoperfusion (HIPEC) and examined their association with clinicopathologic features and survival.

Methods

A total of 176 patients undergoing attempted CRS/HIPEC for appendiceal carcinomatosis had at least 1 tumor marker measured. Marker levels were correlated with tumor characteristics and oncologic outcomes. Kaplan–Meier curves and multivariate Cox regression models were used to identify prognostic factors affecting progression and survival.

Results

At least 1 marker was elevated prior to CRS/HIPEC in 70 % of patients (CEA, 54.1 %; CA19-9, 47.7 %; CA-125, 47.2 %). Among patients with elevated preoperative marker levels, normalization occurred postoperatively in 79.4 % for CEA, 92.3 % for CA19-9, and 60 % for CA-125. Absolute preoperative tumor marker levels correlated with peritoneal carcinomatosis index (PCI) (p < .0002), and the number of elevated markers was associated with PCI and progression-free survival (PFS). Elevated postoperative CEA level was associated with decreased PFS (median, 13 vs 36 months, p = .0008). On multivariate Cox regression analysis, elevated preoperative CA19-9 was associated with shorter PFS (hazard ratio [HR] 2.9, 95 % confidence interval [95 % CI] 1.5–5.3, p = .0008), whereas elevated CA-125 was associated with shorter overall survival (HR 2.6, 95 % CI 1.3–5.4, p = .01).

Conclusions

Most patients with appendiceal carcinomatosis will have at least 1 elevated tumor marker and will normalize following CRS/HIPEC, allowing for ongoing surveillance. CA19-9 is a promising biomarker for early progression following CRS/HIPEC, whereas CA-125 is associated with shorter survival.

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Title: Significance of Serum Tumor Marker Levels in Peritoneal Carcinomatosis of Appendiceal Origin
Authors: Patrick L. Wagner, MD
Frances Austin, MD
Magesh Sathaiah, MD
Deepa Magge, MD
Ugwuji Maduekwe, MD
Lekshmi Ramalingam, MD
Heather L. Jones, MPA-C
Matthew P. Holtzman, MD
Steven A. Ahrendt, MD
Amer H. Zureikat, MD
James F. Pingpank, MD
Herbert J. Zeh III, MD
David L. Bartlett, MD
Haroon A. Choudry, MD
Publication date: 01-02-2013
Publisher: Springer-Verlag
Published in: Annals of Surgical Oncology / Issue 2/2013
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI: https://doi.org/10.1245/s10434-012-2627-5

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Significance of Serum Tumor Marker Levels in Peritoneal Carcinomatosis of Appendiceal Origin

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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